WHO Global Task Force on
TB Impact Measurement Mandate and strategic areas of work:
proposal 2016–2020
Katherine Floyd (WHO/GTB/TME)
Meeting of the WHO Global Task Force on TB Impact Measurement
Glion-sur-Montreux, 19−21 April 2016
1. Mandate and strategic areas of work 2007‒2015
2. The Sustainable Development Goals (SDGs) and the End TB Strategy
3. Implications of the SDGs and End TB Strategy for Task Force mandate and strategic areas of work
4. Other factors with implications for Task Force mandate and strategic areas of work
5. Proposal: mandate and strategic areas of work 2016‒2020
Overview
1. Mandate, strategic
areas of work 2007‒2015
WHO core functions mandated and endorsed by 194 Member States
1. Providing leadership on matters critical to health and engaging in
partnerships where joint action is needed
2. Shaping the research agenda and stimulating the generation,
translation and dissemination of valuable knowledge
3. Setting norms and standards and promoting and monitoring their
implementation
4. Articulating ethical and evidence-based policy options
5. Providing technical support, catalysing change and building
institutional capacity
6. Monitoring the health situation and
assessing health trends
http://www.who.int/about/role/en/
MDG framework, 2000−2015 8 goals and related targets
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal and child health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental stability
8. Global partnership for development
{
http://www.un.org/millenniumgoals/
2015 global TB targets
MDG 6, Target 6c: Halt and reverse TB incidence
Four other MDG indicators for TB:
prevalence, mortality, case detection, treatment success
Halve prevalence and mortality rates compared
with baseline of 1990
To produce a robust, rigorous and widely-endorsed assessment of whether 2015 global targets for reductions in TB incidence, prevalence and mortality are achieved at global, regional and country levels
WHO Global Task Force on
TB Impact Measurement (2006–2015)
1. Strengthening surveillance of TB cases and deaths, all countries
2. National TB prevalence surveys in 22 global focus countries
3. Periodic review of methods to produce disease burden estimates
Mandate
Three strategic areas of work (December 2007)
NTPs of many countries
Contributors
Convened by: WHO/GTB/TME
Chair: Jaap Broekmans
And in particular, 11 long-standing contributors among those at this meeting:
Ibrahim Abubakar, Ana Bierrenbach, Emily Bloss, Martien Borgdorff, Chen-Yuan Chiang, Ted Cohen,
Razia Fatima, Eveline Klinkenberg, Eliud Wandwalo, Marieke van der Werf, Norio Yamada
Global TB monitoring by WHO status at time of last Task Force meeting, April 2015
Data reported by ~200 countries, >99% global population and TB cases
Launched 28 October
Washington DC
20th report
20 years since global TB
monitoring established in WHO
20 rounds of global TB
collection
2015 targets assessment
Transition from MDGs to SDGs,
Stop TB Strategy to End TB
Strategy
2. The SDGs and the
End TB Strategy
Sustainable Development Goals adopted by UN September 2015, for 2016–2030
Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria
and neglected tropical diseases and combat hepatitis, water-borne
diseases and other communicable diseases
Goal 3
Ensure healthy lives
and promote well-
being for all at all ages
17 goals
Indicators: HIV incidence, tuberculosis incidence, malaria incidence,
Hep B incidence, number of people requiring interventions against NTDs
+ disaggregation → inequalities → equity
GLOBAL TB PROGRAMME
67th World Health Assembly, Geneva, May 2014
End TB Strategy
2016−2035
Vision: A world free of TB
Goal: End the Global TB epidemic
(≈10 cases per 100,000 population)
Vision, goal, indicators, targets
INDICATORS
MILESTONES
TARGETS
2020 2025 SDG 2030 End TB 2035
1. Reduction in number of TB
deaths compared with 2015 (%) 35% 75% 90% 95%
2. Reduction in TB incidence
rate compared with 2015 (%)
20%
50%
80%
90%
3. TB-affected households
facing catastrophic costs due to
TB (%)
Zero Zero Zero Zero
For strategy components (10) and principles, see background document 1
The End TB Strategy Global trajectories to reach milestones and targets
10% per year by
2025
4‒5% per year by 2020
Incidence
CFR 10%
CFR 6.5%
TB deaths
Technological
breakthrough
required by 2025,
LTBI
3. SDGs and End TB Strategy implications for Task Force mandate
and strategic areas of work post-2015
1. TB incidence and TB deaths remain high-level indicators Strengthened routine surveillance SAoW* remains necessary
Periodic review of methods SAoW remains necessary
2. Costs faced by TB-affected households is now the third high-
level indicator Should be part of a Task Force SAoW if focus on measurement of
high-level indicators is to remain
3. TB prevalence lower profile National TB prevalence surveys may not justify being an entire SAoW
4. Disaggregation of TB indicators and related assessment
of equity higher profile (disaggregation → inequalities → equity)
Key indicators will need disaggregation e.g. by age, sex, economic
status, location; some will need to allow assessment of equity
5. Estimates of the burden of TB infection higher profile
Five major implications
*SAoW – Strategic Area of Work
4. Other factors with implications for Task Force mandate
and strategic areas of work post-2015
1. Growing demand for dis-aggregations of national
estimates for TB disease burden specifically E.g. by age (adults/children), MDR-TB
2. Importance of analysis and use of data, as well as
data generation
3. Commonalities with drug resistance surveillance Surveillance, surveys, use of rapid tests… integrate in Task Force SAoW?
4. Growing demand for projections: notifications, disease burden
Four other factors
5. Proposal mandate and strategic areas of
work post-2015
Mandate
2016–2020
1. To ensure that assessments of progress towards End
TB Strategy and SDG targets and milestones* at global,
regional and country levels are as rigorous, robust and
consensus-based as possible
2. To guide, promote and support the analysis and use of
TB data for policy, planning and programmatic action
*i.e. TB incidence rate, number of TB deaths, percentage
of TB-affected households facing catastrophic costs
1. Strengthening national notification systems for direct measurement of
TB cases*
2. Strengthening national vital registration systems for direct measurement
of TB deaths
3. Priority studies to periodically measure TB disease burden, including National TB prevalence surveys
Drug resistance surveys
Mortality surveys
TB patient/household cost surveys
4. Periodic review of methods used by WHO to estimate the burden of TB
disease and latent TB infection
5. Analysis and use of TB data at country level, including Disaggregated analyses (e.g. age, sex, location) to assess inequalities and equity
Projections of disease burden
Guidance, tools, capacity building
Strategic areas of work
2016–2020
Selected countries
Selected years
*Including drug-resistant TB and HIV-associated TB specifically